Table 19

Criteria for lineage assignment for a diagnosis of MPAL

Lineage assignment criteria
Myeloid lineage 
 MPO* (flow cytometry, immunohistochemistry, or cytochemistry) 
 or 
 Monocytic differentiation (at least 2 of the following: nonspecific esterase cytochemistry, CD11c, CD14, CD64, lysozyme) 
T-lineage 
 Strong cytoplasmic CD3 (with antibodies to CD3 ε chain) 
 or 
 Surface CD3 
B-lineage 
 Strong CD19 with at least 1 of the following strongly expressed: CD79a, cytoplasmic CD22, or CD10 
 or 
 Weak CD19 with at least 2 of the following strongly expressed: CD79a, cytoplasmic CD22, or CD10 
Lineage assignment criteria
Myeloid lineage 
 MPO* (flow cytometry, immunohistochemistry, or cytochemistry) 
 or 
 Monocytic differentiation (at least 2 of the following: nonspecific esterase cytochemistry, CD11c, CD14, CD64, lysozyme) 
T-lineage 
 Strong cytoplasmic CD3 (with antibodies to CD3 ε chain) 
 or 
 Surface CD3 
B-lineage 
 Strong CD19 with at least 1 of the following strongly expressed: CD79a, cytoplasmic CD22, or CD10 
 or 
 Weak CD19 with at least 2 of the following strongly expressed: CD79a, cytoplasmic CD22, or CD10 
*

See “Acute leukemias of ambiguous lineage” for caveats related to weaker antigen expression, or to expression by immunohistochemistry only.

Strong defined as equal or brighter than the normal B or T cells in the sample.

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